Impaired Cognitive Function in Asymptomatic Carotid artery Disease

From the International Stroke Conference, Dr. C. Balucani enrolled 330 patients from 2005-10. In each of four evaluations, patients with bilateral internal carotid artery stenosis showed significant impairments in both brain hemispheres compared to controls.Patients with unilateral stenosis showed significant impairment only in the brain hemisphere connected to the embarrassed vascular supply.

Memories Blocked..but Recall Restored

HDAC2 ( histone deacetylase 2 ) regulates the expression of genes involved in learning and memory. MIT scientists led by Li-Huei Tsai,PhD blocked the buildup of HDAC2 in a mouse model of Alzheimer's disease and it restored structural and synaptic plasticity allowing mice with symptoms of AD to restore and access memory. This experiment suggests that memories of things learned may still be stored in the brain but overproduction of HDAC2 blocks access to those memories. This finding has already been experimentally replicated.

In another epigenetic part of their study, these researchers found that glucocorticoid receptor 1normally turned on by stress was in fact switched on/activated from the accumulation of Abeta amyloid causing an increase in HDAC2 and chronic blockage of the genes necessary for memory.

For alzheimer's patients , these MIT researchers have developed a potent HDCA2 inhibitor and are preparing to submit papers to the FDA to begin experimental testing.

NATURE 2012 ; 483 (7388):222-226

Also see Science 2012;335(6075):1513-1516 "Generation of a synthetic memory trace"

Potential Treatment for Alzheimer's Disease :Bexarotene

I have been in email communication with the lead investigator Gary Landreth,Ph.D. of Case Western Reserve University ( my father's alma mater ) in my home town of Cleveland, OH as I am very excited about his preliminary findings in using bexarotene ( Targretin ) in mouse models of Alzheimer's disease. This drug has been FDA approved for the treatment of cutaneous T-cell lymphoma, has been in use in humans in this capacity for 10 years and has a favorable safety profile.

In this experiment led by Paige E. Cramer, after a 14 day treatment period, there was a sustained 30% reduction in soluble amyloid-beta levels and a 75% reduction in amyloid-beta plaques ! More to come.....

( Science 2012 Feb 9 )

Double Edged Sword: AMYVID

Amyvid ( florbetapir F18 Injection) was approved by the FDA on April 10th for the imaging of amyloid using positron emission tomography (PET) in adults being evaluated for Alzheimer's disease. The problems : what constitutes a definitively abnormal scan ? If a scan reveals significant amyloid burden, then what ? CSF biomarkers can aid the neurological exam and establish a diagnosis with better than ever sensitivity, but then what ? As we have no definitive cure for the disease......stay tuned as hope is on the horizon !

PS. This test is not currently covered by Medicare...cost to consumer $3000.00

A WORLD'S FIRST: A Parkinson's Vaccine

Phase I study of the AFFIRIS AG Parkinson's candidate PD01A has begun.PD01A targets alpha-synuclein and induces antibodies to neutralize its toxic impact potentially modifying the diseases course. This is a "First-in-man""First-in kind"trial that will enroll 32 patients to be the pioneers of this immunotherapy of Parkinson's disease.

www.affiris.com

Dizziness Update

DIZZINESS
HC-BPPV ( apogeotropic horizontal canal benign paroxysmal positional vertigo ) Tx=Gufoni maneuver
Neurology 2011; E-pub Dec 14

MS Update in Pregnancy

Multiple Sclerosis
Glatiramer acetate = in pregnancy
Continuum 2010;16(5):193-210
Rebif 22 mcg sc qod then 44mcg
(Interferon beta 1-a)
REFLEXION study sc beta I nterferon-1a 44mcg 3X/wk ...early(AAN2012)